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SAN JOAQ N COUNTY PUBLIC HEAL'T'H SERTrIC7S <br /> JOA <br /> HEALTH DIVISION 0 <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j ) <br /> Facility NameMg P � wv eve/ CGPc�'DC-k <br /> Address x 2 0 �� t�—� 26c ` ` <br /> City J -bC��O� SZ ) <br /> IX I All inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code Of RegU{.�tions, <br /> Division 3 , Chapter 16, Section 2646, for the 12 month period from <br /> Z.V\ 19 q to 2\ 194 j . <br /> ❑ Inventory variations in excess of the allowable limits Of Section <br /> 2646, occurred as listed below. <br /> DATE TANK # / PRODUCT AMOUNT (Gallons) <br /> Submit report within 15 days following the end of the last mot <br /> of <br /> 12-month period covered by the report. Report to be submitted to: the <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SZRVICES <br /> ENVIRONKENTAL HEALTH DIVISION <br /> P.O. BOX 2009 <br /> STOCXTONf CA 95201 <br /> I certify under penalty of perjury, that all variations (if any) <br /> exceeding allowable limits are indicated above (California Health & <br /> Safety Code, Section 25299) : <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />